PREDICTORS OF FUNCTIONAL ABILITY VARY BY AGE

Abstract Across adulthood, chronic physical and emotional conditions can interfere with wellbeing. We examined the potential moderating effect of age on the process functional ability Using data from 401,958 adults who completed the 2020 Behavioral Risk Factor Surveillance System survey, we tested the associations among age, sex, race, chronic health conditions, poor mental health, and functional ability. The initial model was a poor fit to the data, χ 2 (DF = 24) = 592039, p > .001; RMSEA = .25. In order to examine whether this poor fit was related to age differences in the model, we removed age as a predictor and included it as a moderator. Thus, we tested the model among 122,005 younger adults, 140,122 midlife adults, and 139,831 older adults. The model fit improved, χ 2 (DF = 54) = 567119.79 p > .001; RMSEA = .25. Variance accounted for in functional ability differed, with 22% among younger adults, 33% at midlife, and 20.5% for older adults. Additional post hoc analyses were conducted and suggest alternate pathways to functional wellbeing across the lifespan. Our results are discussed the within the context of expanding investigations of functional wellbeing to include a set of predictors which captures both common and unique pathways across age.

The World Health Organization (WHO) proposed the Integrated Care for Older People (ICOPE) approach to guide health systems in better supporting the intrinsic capacity and functional ability of older adults to enable healthy aging (Briggs et al., 2018;de Carvalho et al., 2019).This approach is aligned with Singapore's Healthier SG initiative, which aims to build a good healthcare system that promotes better health and quality of life for everyone.Recent studies have shown that older adults experience intrinsic capacity decline in various countries, including Singapore, highlighting the importance of targeted interventions to maintain functionality and quality of life in old age (Beard et al., 2019;Liu et al., 2021;Tay et al., 2022).In this cross-sectional study, 367 participants were assessed by 43 ICOPE assessors, of whom 77.4% (n=284) had impairments in intrinsic capacity.The three most prevalent intrinsic capacity impairments were visual impairment (42%), hearing loss (33.5%), and cognitive decline (31.3%), followed by limited mobility (24.3%), malnutrition (16.1%), and depressive symptoms (16.1%).Furthermore, 22.6% of participants were unaware of any elderly care services available in the community, and 8.2% did not know where to seek help in case of problems.These findings emphasize the need for ICOPE assessments at the community level to promote early detection of intrinsic capacity impairments and interventions.More discussion of the care pathway, together with health professionals, older adults, and caregivers, should be the next step to offer diagnostic assessment and guide self-management of intrinsic capacity impairment for among older adults.

LONG-TERM EFFECTS OF EDUCATION ON LATE-LIFE DEPRESSION OF RURAL WOMEN IN CHINA
Lynn Hu, Pardee RAND Graduate School, Santa Monica, California, United States Despite the noted association between educational attainment and mental health, there is considerable debate on whether this relationship is causal.Up to now, there are only a few studies using credible estimation strategies to examine the causal impact of education on mental health, and almost no evidence exists for low and middle-income developing countries from regions like Asia.This is concerning given that mental health problems and late-life depression are growing in the Asian population, especially for women and rural residents.In this paper, I aim to fill the gap by examining the long-term causal effect of additional educational attainment on the depressive symptoms of rural women in China.Using Harmonized CHARLS data, I leveraged the sudden end of the Chinese Cultural Revolution in 1976 as an exogenous shock to education, and employed both event study and regression discontinuity designs to estimate its causal effect on latelife depressive symptoms.Results show a protective effect of education for the rural women who stayed in rural areas, and a negative impact of education on the urbanized rural women.The impacts are likely to be mediated by childhood adversities (being poor and unhealthy), marriage status (being widowed), and disability status (difficulty in performing activities necessary for independent living).The proposed research will be the first study to examine the causal effect of education on the mental health of the Chinese population.It will add to the existing literature by providing evidence from underdeveloped regions in Asian countries and offering insights for future policymaking.

MEDICARE ADVANTAGE (MA) PLAN CHARACTERISTICS ON PHYSICAL AND MENTAL HEALTH OUTCOMES OF MA BENEFICIARIES Rashmita Basu, East Carolina University, Greenville, North Carolina, United States
With growing demands for better and cost-effective care delivery by Medicare Advantage (MA) plans, comparison of self-reported health outcomes is more important because those outcomes capture patients' experiences and perspectives.The purpose of the study is to examine the characteristics of MA plans on Medicare beneficiaries' physical and mental health status.Methods: I used the Medicare Health Outcomes (HOS) survey, a random sample of Medicare beneficiaries surveyed from each MA plan with a minimum of 500 enrollees conducted by the CMS.The current study included 3 baseline cohorts from 2015 (n=195,800), 2016 (n=178,973), and 2017 (n=172,047).I used physical component summary (PCS) and mental component summary (MCS) scores as two outcomes which include various domains of physical (exercise, pain, activity limitation) and mental health (social functioning, emotional status, depression) status.Plan characteristics include plan ownership status (for-profit (FP) vs. not-for-profit (NFP), plan types (PPO vs. HMO/cost contract), and the number of plan members.I used the linear regression method with clustering at the plan contract level due to the correlation of multiple beneficiaries within the same plan.Results: Adjusted for beneficiary level characteristics, beneficiaries in PPO plans experienced greater physical and mental health scores than HMO or cost contract plans.MA plan with less than 5k beneficiaries is associated with a lower physical health score than plans with more than 100k beneficiaries.For-profit ownership was significantly associated with lower mental health scores.Discussion: The characteristics of MA plan insurers are important factors for beneficiaries' enrollment decisions and quality improvement efforts.

PREDICTORS OF FUNCTIONAL ABILITY VARY BY AGE
Carly Pullen, and Julie Hicks Patrick, West Virginia University, Morgantown, West Virginia, United States Across adulthood, chronic physical and emotional conditions can interfere with wellbeing.We examined the potential moderating effect of age on the process functional ability Using data from 401,958 adults who completed the 2020 Behavioral Risk Factor Surveillance System survey, we tested the associations among age, sex, race, chronic health conditions, poor mental health, and functional ability.The initial model was a poor fit to the data, χ 2 (DF = 24) = 592039, p >

THE IMPACT OF CLOSING MEDICARE PART D COVERAGE GAP ON MENTAL HEALTH OF OLDER ADULTS Junjie Gai, and Kanika Arora, University of Iowa, Iowa City, Iowa, United States
The ACA mandated the gradual elimination of the Medicare prescription drug coverage gap (also called the "Doughnut Hole") beginning in 2011.This policy change can impact mental health through mechanisms such as reduction in out-of-pocket (OOP) expenses and increased access to prescription medication.However, no previous study has examined its impact on mental health outcomes of older adults on Medicare.Employing data from the Medical Expenditure Panel Survey (from 2006 to 2016), compare the mental health of Medicare beneficiaries (66-70 years; N=7,664) with that of non-Medicare beneficiaries (60-64 years; N=8,079) before versus after policy implementation.We find that the 2011 phasing out of Medicare drug coverage gap was associated with 0.86-point (p< 0.05) improvement in the Mental Component score of the Short-Form 12 Health Survey among beneficiaries.Our analysis was robust to using alternate measures of mental health outcomes (Kessler Index and PHQ-2) as well as to an alternate construction of treatment and control groups (comparing individuals aged 60-70 years on Medicare and private insurance).We find no detectable differences in the mental health of Medicare beneficiaries who already receive subsidies for costs associated with the coverage gap through the Low Income Subsidy (LIS) program.Further, we find that elimination of the doughnut hole reduced OOP expenses by $32.65 among Medicare beneficiaries in our sample.Overall, our results for mental health and OOP expenses are mainly attributable to women.This evidence highlights indirect effects of drug coverage gap elimination on mental health outcomes among Medicare beneficiaries.This project explores whether companion robotic pets improve mental well-being of community-dwelling older women with depression.Depression is a major mental health issue disproportionately impacting women due to lifelong experiences of sexism and limitations in education and employment.Aging exacerbates an already undervalued status, and feelings of powerlessness increase.Women thus experience double jeopardy from discrimination on both gender and age (Hooyman et al., 2017).This project will investigate the efficacy of companion robotic pets and will recommend plans to the local Office for Aging (OFA).Recruitment was done in collaboration with the local OFA, with mail-survey data collected from community-dwelling women over the age of 65. 38 participants were provided with a robotic pet after an initial screening.Following a one-group pretest posttest design, data from 31 participants were used to determine the impact